Improving Identification of Firearm Access in Children With Mental Health Complaints.

OBJECTIVE: To determine if electronic medical record (EMR) changes and implementation of a study on firearm storage practices changed identification of firearm exposure in children presenting to a pediatric emergency department (PED) with mental health complaints. We also sought to determine the accuracy of information collected on firearm storage practices. METHODS: Retrospective study of EMR documentation of firearm exposure in PED patients with mental health complaints from January 20, 2015 until November 20, 2017. EMR changes occurred on January 20, 2016 and the firearms study began on February 13, 2016. The primary outcome was documentation of firearm exposure. Secondary outcomes were documentation of unsafe firearm storage practices. We also examined differences between clinical and research documentation of unsafe firearm storage practices post-intervention. We compared groups using descriptive statistics and chi-squared tests. We used statistical process control to examine the relationship between interventions and changes in outcomes. RESULTS: 5582 encounters were examined. Identification of firearm exposure increased from 11 to 17% postintervention. Identification of unsafe storage practices increased from 1.9% to 4.4% across all encounters. Special cause variation in both metrics occurred concurrently with the interventions. Postintervention, unsafe firearms storage practices in firearm owning families were under-identified (39% identified as not triple-safe in clinical data vs 75% in research data). CONCLUSIONS: EMR changes and implementation of a firearms study improved identification of firearm exposure and unsafe storage practices in families of PED patients being evaluated for mental health complaints. However, unsafe storage practices continued to be under-identified in firearm-owning families.

"Am I a student or a Healthcare Assistant?" A qualitative evaluation of a programme of prenursing care experience.

AIM: To examine the experiences of prenursing healthcare assistants (HCA) during a 6-month programme of prenursing care experience. BACKGROUND: Care experience prior to commencing programmes of nurse education is broadly considered to be advantageous. However, it is not clear how formal care experience prior to nurse education has an impact on the values and behaviours of the aspirant nurse. DESIGN: A longitudinal prospective qualitative study using focus group discussions. METHODS: Data were collected from 23 prenursing HCA during September 2013-February 2014. Three focus groups were held at the beginning, middle, and end of the programme of care experience at each of the participating hospitals. A thematic analysis was used to analyse data sets from each hospital. Findings from each hospital were then compared to reach final themes. RESULTS: Five major themes were identified in the analysis of qualitative data: personal development; positioning of role in the healthcare team; support and supervision; perceived benefits; and advice and recommendations. These themes were underpinned by deep aspirations for better care and better nurses in the future. CONCLUSIONS: Prenursing care experience can positively prepare aspirant nurses for programmes of nurse education. The benefits identified were confirmation of aspiration (or otherwise) to pursue nursing, learning opportunities, and aspiration to improve patient experience. Risks for the programme included poor supervision, role ambiguity or confusion, demotivation through a deteriorating view of nursing, and poor treatment by others. The longer term impact on values and behaviours of this cohort requires further evaluation.

A Kinect-based movement assessment system: marker position comparison to Vicon.

Accurate movement analysis systems are prohibitive in cost and size to be accessible to the general population, while commercially available, affordable systems lack the accuracy needed for clinical relevance. To address these limitations, we developed a Depth Camera Movement Assessment System (DCMAS) featuring an affordable, widely available depth camera (e.g. Microsoft Kinect). After examining 3D position data for markers adhered to participants and a flat surface, captured with both DCMAS and the industry standard Vicon system, we demonstrated DCMAS obtained measurements comparable, within soft tissue artifact, to the Vicon system, paving the way for a breakthrough technology in preventative medicine.

Verifying the equivalence of representations of the knee joint moment vector from a drop vertical jump task.

Biomechanics software programs, such as Visual3D, Nexus, Cortex, and OpenSim, have the capability of generating several distinct component representations for joint moments and forces from motion capture data. These representations include those for orthonormal proximal and distal coordinate systems and a non-orthogonal joint coordinate system. In this article, a method is presented to address the challenging problem of evaluating and verifying the equivalence of these representations. The method accommodates the difficulty that there are two possible sets of non-orthogonal basis vectors that can be used to express a vector in the joint coordinate system and is illuminated using motion capture data from a drop vertical jump task.

Experiences of overseas nurses recruited to the NHS.

Overseas staff have been described as the 'saviours of British nursing' and it has been mooted that some healthcare organisations, particularly in the independent sector, would cease to function without them (Buchan 2003). This article discusses a review of the experiences of migrant nurses who came to the U.K. between 1995 and 2007, focusing on the implications of its findings for senior nurses and managers. It also makes recommendations for the future recruitment and retention of internationally recruited nurses.

The experiences of internationally recruited nurses in the UK (1995-2007): an integrative review.

AIM: This review explores the experiences of international nurses recently recruited to the UK nursing workforce (1995-2007) and the implications for retention. BACKGROUND: An acute shortage of nurses in the mid 1990s, combined with policy initiatives to increase the number of qualified nurses working in the NHS, resulted in an active campaign to recruit nurses from overseas. Since 1997, approximately 100,000 international nurses have been admitted to the nursing register from more than 50 countries worldwide. Many practice areas are now dependent on overseas nurses as an essential part of their workforce. DESIGN: An integrative review. METHOD: The review was conducted using a range of electronic databases to capture the experiences of this cohort of migrant nurses. CONCLUSION: Much literature has been generated over the past decade in relation to the experiences of international nurses recruited during this campaign. Five main themes emerged from the review: motivation for migration, adapting to British nursing, experiences of first world healthcare, feeling devalued and deskilled and vectors of racial discrimination. Although some positive experiences are described, significant numbers of nurses describe not feeling personally or professionally valued by the UK nursing establishment, common emotions expressed are disappointment and unmet expectations. This will have implications for job satisfaction and intention to leave or stay. RELEVANCE TO CLINICAL PRACTICE: If overseas nurses choose to leave the UK in large numbers, the health services could face a severe staffing shortage. It is important that we listen carefully to their experiences to help identify priorities for policy and practice aimed at improving job satisfaction for migrant nurses and articulating the value that they bring to UK nursing.